Provider Demographics
NPI:1821404807
Name:LY, LAN Q (MD)
Entity Type:Individual
Prefix:
First Name:LAN
Middle Name:Q
Last Name:LY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1133 COLLEGE AVE STE D200
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-2776
Mailing Address - Country:US
Mailing Address - Phone:785-537-4940
Mailing Address - Fax:785-537-0836
Practice Address - Street 1:1133 COLLEGE AVE STE D200
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-2776
Practice Address - Country:US
Practice Address - Phone:785-537-4940
Practice Address - Fax:785-537-0836
Is Sole Proprietor?:No
Enumeration Date:2014-07-10
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS04-38567207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine